Research Roundup: Financing boomers' care; California's budget cuts; Racial disparities in surgical outcomes

Feb 20 2010

Health Affairs: Chronic Conditions Account For Rise In Medicare Spending From 1987 To 2006 - "Medicare beneficiaries' medical needs, and where beneficiaries undergo treatment, have changed dramatically over the past two decades." For example, the authors write, "heart disease ranked first among the top-ten conditions in terms of attributable share of growth from 1987 to 1997, accounting for nearly 14 percent of the increase in Medicare spending." But from "1997 to 2006 ... heart conditions fell… accounting for just 0.25 percent of spending growth. A very different pattern of spending emerged between 1997 and 2006 … diabetes, arthritis, hyperlipidemia, kidney disease, hypertension, and mental disorders—accounted for more than a third of the rise in Medicare spending."

They conclude: "The U.S. health system remains predicated on providing acute, episodic care that is inadequate to address the altered patterns of disease now facing the American public. Our results highlight the need for prevention and care outside doctors' offices and hospitals designed to address the changing needs of patients at risk for or living with chronic disease and, often, multiple comorbidities" (Thorpe, Ogden and Galactionova, 2/18).

Urban Institute: Will Health Care Costs Bankrupt Aging Boomers? - "Although Medicare covers nearly all adults age 65 and older, premiums, deductibles, copays, and holes in the benefit package leave many older Americans with substantial out-of-pocket expenses," write the researchers who used a microsimulation model to estimate income and out-of-pocket medical expenses and insurance premiums for Americans age 65 and older from 2010 to 2040: "In 2040, half of adults age 65 and older will spend at least 19 percent of their household incomes on health care, up from 10 percent in 2010, if costs grow at the intermediate rate projected by the Medicare trustees. About 7 in 10 older Americans in the bottom two-fifths of the income distribution will spend more than 20 percent of their incomes on health care in 2040." They conclude, "The projections underscore the need to control rising health care spending. … steady cost growth threatens to bankrupt Medicare and strain the federal budget, potentially crowding out other government priorities" (Johnson and Mommaerts, 2/4).

UCLA Center For Health Policy Research: Budget Proposals Turn Back Clock 30 Years In Long-Term Care Services For California Seniors - This policy brief, based on data from nine California counties, analyses the impact the 2010-2011 California budget proposal could have on low-income seniors, their caregivers and service providers. "The size and scope of the proposed reductions would weaken community supports to levels not seen for almost 30 years ... California's seniors and persons with disabilities, their families and those who help them remain in the community, often at low wages, deserve public policies that serve long-established human service goals. The cuts proposed in January 2010 not only do not meet this standard, they represent a dramatic shift away from the policy of supporting vulnerable elders and persons with disabilities in the community" (Wallace et al., Feb. 2010).

Archives of Surgery: Racial And Ethnic Differences In The Use of High-Volume Hospitals And Surgeons - The authors analysed the cases of more than 130,000 patients who underwent 1 of 10 surgical procedures -  for where hospital and patient volume influences a patient's short-term risk of death (cancer, cardiovascular and orthopedic surgery) -  in the New York City area: "Even after adjusting for a broad range of relevant factors, compared with white patients, treatment at high-volume hospitals by high-volume surgeons was lower by 11.8 percentage points for black patients, 8.0 percentage points for Asian patients, and 7.0 percentage points for Hispanic patients on average across the 10 study procedures." The authors reflect on several possible explanations for the disparities in provider selection before concluding, "In addition to efforts to improve the quality of care among providers serving minority patients, policymakers and clinicians may be able to improve outcomes by encouraging minority patients and their surrogates to consider comparative performance information when choosing hospitals and surgeons" (Epstein, Gray and Schlesinger, Feb. 2010).

Center for Studying Health Systems Change/Robert Wood Johnson Foundation: Modest And Uneven: Physician Efforts To Reduce Racial And Ethnic Disparities - Despite the recognition by U.S. physicians that language and cultural communication barriers serve as obstacles to providing high-quality care, "physician adoption of practices to overcome such barriers is modest and uneven." Based on the results of a nationally-representative mail survey of U.S. physicians, the authors write: "physician adoption of several recommended practices to improve care for minority patients ranges from 7 percent reporting they have the capability to track patients' preferred language to 40 percent reporting they have received training in minority health issues to slightly more than half reporting their practices provide some interpreter service." They add, "Cost and lack of reimbursement for these activities are likely among the largest obstacles to implementation in physician practices," the authors write (Reschovsky and Boukus, Feb. 2010).

George Washington University School Of Public Health And Health Services (.pdf): The Economic Stimulus: Gauging The Early Effects Of ARRA Funding On Health Centers And Medically Underserved Populations and Communities - The $1.85 billion the American Recovery and Reinvestment Act (ARRA) poured into community health centers "translates into $3.2 billion in new economic activity in these communities." The findings indicate "ARRA has achieved its goal of directing resources into those communities that tend to bear the heaviest burden of an economic downturn, and have low community incomes, a disproportionate percentage of low wage workers, inadequate primary care access, and elevated health risks." The authors also note the "challenge lies in sustaining this expansion and assuring that the ability of health centers to respond to community needs is maintained even as overall economic circumstances begin to improve" (Shin et al., 2/16).

Related KHN story: Community Health Centers Providing Return On Investment (Villegas, 2/17).

Institute of Medicine: Provision Of Mental Health Counseling Services Under TRICARE - This book was authored by The Committee on the Qualifications of Professionals Providing Mental Health Counseling Services under TRICARE, Board on the Health of Select Populations. The report brief concludes: "Our nation's service members and their families have significant mental health services needs. In order to ensure that they receive the appropriate diagnosis and treatment, TRICARE should assure that all mental health providers, including counselors, are provided with a practice environment that facilitates high quality care through appropriate scopes of practice, education on the particular problems and needs of the patient population, promotion of evidence-based practices, monitoring of outcomes, and application of quality improvement strategies. As part of that quality management system, counselors should be allowed to practice independently when their education, training, and clinical experience have prepared them to meet the needs of the TRICARE beneficiary population" (2/12).

PLoS Medicine: Can Broader Diffusion of Value-Based Insurance Design Increase Benefits From US Health Care Without Increasing Costs? Evidence From A Computer Simulation Model - This study examines the impact of value-based insurance design (VBID), "an approach in which the amount of cost sharing is set according to the 'value' of an intervention rather than its cost," on U.S. health care benefits and cost. Researchers used a computer simulation "to estimate the impact of applying VBID to cost sharing for drugs alone and to cost sharing for drugs, procedures, and other health care services for one million hypothetical US patients. ... Broader diffusion of VBID to pharmaceuticals increased the benefit conferred by health care by 0.03 to 0.05 additional life-years, without increasing costs and without increasing out-of-pocket payments. Broader diffusion of VBID to other health care services could increase the benefit conferred by health care by 0.24 to 0.44 additional life-years, also without increasing costs and without increasing overall out-of-pocket payments" (Braithwaite et al., 2/16).